| NPI | 1962957480 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12224) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2020-09-18 |